Provider Demographics
NPI:1770798670
Name:COHEN GLAZER, SYBIL PADER (RD CDN MS MA)
Entity type:Individual
Prefix:MS
First Name:SYBIL
Middle Name:PADER
Last Name:COHEN GLAZER
Suffix:
Gender:F
Credentials:RD CDN MS MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 CHAPEL PLACE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1413
Mailing Address - Country:US
Mailing Address - Phone:516-829-5703
Mailing Address - Fax:516-829-2474
Practice Address - Street 1:21 CHAPEL PLACE
Practice Address - Street 2:SUITE 1A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1413
Practice Address - Country:US
Practice Address - Phone:516-829-5703
Practice Address - Fax:516-829-2474
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000366133N00000X
NY808119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000866OtherMHC
NY000366Medicaid
NYP419902OtherOXFORD
NY8099994OtherGHI
NYQN00332OtherASH
NYP419902OtherOXFORD